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CO HCPF Physical and Occupational Therapy Billing Manual — Coding Tables
CodingTables
Thefollowingplaceofservicecodesareallowed:
PlaceofService(POS)code
Description
02
Telemedicine-Notprovidedinpatient’shome(onlyapplicabletocertainprocedurecodes).RefertotheTelemedicineBillingManual.
03
School
10
Telehealth-Providedinpatient’shome.RefertotheTelemedicineBillingManual.
11
Office
12
Home
13
AssistedLivingFacility
62
ComprehensiveOutpatientRehabilitationFacility
99
Other-communitylocation
EffectiveMay3,2024,placeofservice03isanallowedplaceofserviceforallfee-for-servicebenefits.Inorderforcommunityproviderstobillfee-for-servicetochildreninaschoolsetting,theprovidermustfollowschooldistrictpolicy.PleasereferencetheCommunityProvidersinaSchoolSettingPolicyMemo.
Telemedicineplaceofservice(POS)code02isavailableforspecificprocedurecodes.VisittheTelemedicine-ProviderInformationwebpageforalistofallowedprocedurecodes.
TherapyservicesprovidedatanOutpatientHospitalarereportedontheinstitutionalclaimtypeandarereimbursedaspartofthehospital'sEAPGpayment.InstitutionalclaimtypesdonothavethePOScodefield.
TherapyservicesprovidedataFederallyQualifiedHealthCenter(FQHC)andRuralHealthClinic(RHC)arebilledaspartoftheencounterrateforthecenter.Theymustnotbebilledseparatelyonprofessionalclaims.
POScode'99'isusedforcommunitylocations(suchasalibraryorgrocerystore)whereservicestookplacewhicharenotbetterdescribedas'home',whichisforthemember'splaceofresidence.
EarlyInterventionprovidersmayreportanyPOScodewhichalignswiththetreatmentorderedbythechild'sIndividualizedFamilyServicePlan.
OutpatientTherapyType
Modifier1
Modifier2
RehabilitativePhysicalTherapy
GP
97
RehabilitativeOccupationalTherapy
GO
97
HabilitativePhysicalTherapy
GP
96
HabilitativeOccupationalTherapy
GO
96
EarlyInterventionPhysicalTherapy
GP
TL
EarlyInterventionOccupationalTherapy
GO
TL
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PhysicalandOccupationalTherapistsareindicatedasrenderingprovidersforthefollowingprocedures.RefertothecurrentFeeScheduleforrates.Evaluationandorthoticservicesarenotsubjecttothe48-unitlimit.
Thistableservesonlyasareferenceguideandnotaguaranteeofpaymentorcoverage.DefinitivecoverageofaspecificprocedurecodeisfoundontheFeeSchedule.
Reportprocedurecodes97001,97002,97003,97004forevaluationservicesperformedpriorto12/31/2016.Reportprocedurecodes97161-97168forevaluationservicesperformedon/after1/1/2017.
NCCIMUEsstipulatemaximumdailyunitsforeachcode.VisittheNCCIwebpageforfurtherinformation.
ProvidersshouldreferenceofficialAMACPTresourcesforfulldescriptionsofcodesandinstructionforproperuse.
TableUpdated:July2024
ProcedureCode
ProviderType
PriorAuthorizationRequired
Comments
92526
OT
DoesnotrequireaPARforthefirst12units;requiresaPARafter12unitsareutilized.
Note:TheDepartmentstates12unitsforCPTcode92526,insteadof48units.CPTcode92526isanuntimedcodewhichrepresentsamaximumofone(1)unitof92526pervisit.
90911
PT,OT
No
Ended12-31-2019
90912
PT,OT
No
Effective1-1-2020
90913
PT,OT
No
Effective1-1-2020
96112
PT,OT
No
Effective1-1-2020
96113
PT,OT
No
Effective1-1-2020
97010
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97012
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97014
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97016
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97018
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97022
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97024
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97026
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97028
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97032
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97033
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97034
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97035
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97036
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97110
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97112
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97113
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97116
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97124
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97127
-
-
NotCovered.RefertoG0515.
97129
PT,OT
Always
Effective1/1/2020
97130
PT,OT
Always
Effective1/1/2020
97140
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97150
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97161
PT
No
97162
PT
No
97163
PT
No
97164
PT
No
97165
OT
No
97166
OT
No
97167
OT
No
97168
OT
No
97530
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
G0515
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
Closed12/31/2019
97533
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97535
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97537
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97542
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97545
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97546
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97597
PT,OT
No
97598
PT,OT
No
97602
PT,OT
No
97750
PT,OT
No
97755
PT,OT
Always
Modifiers96or97arenotrequiredforthisprocedurecodeasthisevaluationcannotbeclassifiedaseither'rehabilitative'or'habilitative'.
97760
PT,OT
No
97761
PT,OT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
97763
PT,OT
No
20560
PT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
Effective1/1/2020
20561
PT
DoesnotrequireaPARforthefirst48units;requiresPARafter48unitsareutilized.
Effective1/1/2020
L1902
PT,OT
No
L1960
PT,OT
No
L3730
PT,OT
No
L3763
PT,OT
No
L3764
PT,OT
No
L3808
PT,OT
No
L3900
PT,OT
No
L3906
PT,OT
No
L3908
PT,OT
No
L3912
PT,OT
No
L3919
PT,OT
No
L3923
PT,OT
No
L3925
PT,OT
No
L3929
PT,OT
No
L3933
PT,OT
No
L3982
PT,OT
No
Q4040
PT,OT
No
Q4048
PT,OT
No
RefertotheDurableMedicalEquipment,Prosthetics,OrthoticsandSupplies(DMEPOS)BillingManuallocatedontheBillingManualswebpageundertheCMS1500(Professional)drop-downsectionforfurtherbillinginformationontheaboveorthotic/prostheticcodes.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
1b23f05c69cb0f4e36632fb9e27346d88673c12d5c112204b012acbbabe4be12
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